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D. N. Gadelha, R. V. Urbano, B. M. Cavalcanti, A. S. L. Escarião, V. B. Filho; Ultraviolet A/Riboflavin Corneal Cross-Linking for Bullous Keratophaty. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5464.
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Biomechanical, thermo-mechanical, and biochemical properties of the cornea can be modified by using ultraviolet light in combination with riboflavin to induce cross-links within or between corneal collagen molecules. Wollensak et al. demonstrated that collagen cross linking using riboflavin and ultraviolet A (UVA) led to less edema in the cross linked portion of the cornea than in the untreated area, this increase the biomechanical strength of the cornea and reduce symptoms (such as pain and photophobia). The aim of the study is to assay the corneal cross-linking (CCL) effect on the sintomatic Bullous keratopathy, and its impact on the visual acuity, corneal thickness and pain sintomalogy.
Patients who underwent clinical examination at the Altino Ventura Foundation and had BK with simptons were included. A clinical examination with a specific survey (pain scale - visual numeric analog scale), visual acuity (ETDRStm), and corneal thickness measures (Ultrasonic Pachometer Model 850, Humphrey) were done pre CCL, 7, 30 and 60 days after. In all patients, the treatment with the UVA-crosslinking (Opto Global Pty Ltd) was done after the abrasion of the cornea on the slit-lamp and riboflavin drops in a concentration of 400moms for every five minutes for 30 minutes. After this time the patient did the UVA crosslinking exposure using riboflavin and topical anesthesia every five minutes for another 30 minutes. The patient was given antibiotics drops and artificial tears until complete reepithelization. The Friedman test was used to compare the visual acuity, pain symptoms e pachimetry. The ‘p’ less then 0,05 was considered with statistical relevance.
Twelve eyes from 12 patients with recurrent epithelium erosions were treated. The mean follow up visits were 3 months. The statistical analyses showed a reduction of pain (figure 1) with p value less then 0,001. The corneal thickness measures and visual acuity had no statistical relevance.
In conclusion we can suggest that the corneal cross-linking with UVA and riboflavin can be an option to treat the pain from decompensate corneas in patients with poor visual prognosis.
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